Note: Aspects of this work were presented in abstract form at the 28th Internal Symposium on Diabetes and Nutrition Oslo, Norway, 1–4 July 2010 (70), and the International Diabetes Federation, World Diabetes Congress 2011, Dubai, United Arab Emirates, 4–8 December 2011 (71).

From Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Clinical Nutrition and Risk Factor Modification Centre, Division of Endocrinology and Metabolism, and Keenan Research Center of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Faculty of Medicine and Dalla Lana School of Public Health, University of Toronto, Heart and Stroke Foundation of Ontario, and Research Institute Hospital for Sick Children, Toronto, Ontario, Canada; Harvard School of Public Health, Boston, Massachusetts; and College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.

At least 3 reviewers identified controlled feeding trials lasting 7 or more days that compared the effect on body weight of free fructose and nonfructose carbohydrate in diets providing similar calories (isocaloric trials) or of diets supplemented with free fructose to provide excess energy and usual or control diets (hypercaloric trials). Trials evaluating high-fructose corn syrup (42% to 55% free fructose) were excluded.

Data Extraction:

The reviewers independently reviewed and extracted relevant data; disagreements were reconciled by consensus. The Heyland Methodological Quality Score was used to assess study quality.

Data Synthesis:

Thirty-one isocaloric trials (637 participants) and 10 hypercaloric trials (119 participants) were included; studies tended to be small (<15 participants), short (<12 weeks), and of low quality. Fructose had no overall effect on body weight in isocaloric trials (mean difference, −0.14 kg [95% CI, −0.37 to 0.10 kg] for fructose compared with nonfructose carbohydrate). High doses of fructose in hypercaloric trials (+104 to 250 g/d, +18% to 97% of total daily energy intake) lead to significant increases in weight (mean difference, 0.53 kg [CI, 0.26 to 0.79 kg] with fructose).

Limitations:

Most trials had methodological limitations and were of poor quality. The weight-increasing effect of fructose in hypercaloric trials may have been attributable to excess energy rather than fructose itself.

Conclusion:

Fructose does not seem to cause weight gain when it is substituted for other carbohydrates in diets providing similar calories. Free fructose at high doses that provided excess calories modestly increased body weight, an effect that may be due to the extra calories rather than the fructose.